A recent study on the impact of management consultants on public service efficiency, published in Policy & Politics, prompted this letter from the authors calling for a moratorium on their use until effective governance is established.

Open letter to the Rt Hon Jeremy Hunt MP, Secretary of State for Health and Social Care

2nd July, 2018

Dear Mr Hunt,

Re Calling for a moratorium on the use of external management consultants in the NHS until effective governance is established

We recently conducted independent research on the use of external management consultants in the NHS in England. This was subjected to peer review to establish the rigour of its analysis and published in an academic journal (Policy & Politics). Since then, it was mentioned in a parliamentary debate (23rd April, 2018, Hansard Volume 639) and widely reported in the media (21st February, 2018), including in The Times, which has also seen this letter. Continue reading →

Fiona explains how a new questionnaire could be used to increase healthy food and drink options in hospital retail outlets

At the National Institute for Health Research (NIHR), Bristol Biomedical Research Centre we are interested in the role the NHS plays in promoting good nutrition and health in children. Recent reports have shown a quarter of children in the UK are overweight or obese; a worrying statistic in itself, and the problem doesn’t appear to be getting any better.

NICE guidelines say that retail outlets in hospitals such as shops, cafes, restaurants and vending machines should offer healthy food and drink options, and that these options should be prominently displayed. They also say that nutritional information about the foods on their menus should be available. These guidelines do not refer to foods served to patients, although patients may have access to foods and drinks for sale onsite.

At NIHR Bristol Biomedical Research Centre we developed a new questionnaire to help NHS Trusts assess how healthy their food and drink options are. This differs from other questionnaires in that it allows Trusts to compare their findings with the NICE guidelines. Trusts can use this questionnaire to measure how healthy prepared foods for sale are, and can make changes accordingly. These changes may involve, replacing sugary drinks with sugar-free options such as water, and replacing chocolate bars with more healthy options such as unsalted nuts.

Using this questionnaire, we measured how healthy the foods and drinks were in two Trusts, and how closely they followed NICE guidelines. Our findings showed a lack of healthy food and drink options for sale in vending machines. Nutritional information on menus was minimal, and there was limited promotion and advertising of healthy foods and drinks. Since the findings were published, both of the Trusts have made improvements.

Our plan is to further develop the questionnaire in conjunction with the NICE guidelines, so that it can be used more widely in NHS Trusts and in local authority settings, such as leisure centres. Making it easier for parents to direct their children to healthier choices should be a central element of our healthcare system.

Disclaimer: This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Over a billion NHS prescription medicines are issued by pharmacists in England every year – at a cost of over £9 billion. Many of these are prescribed by GPs to manage long-term health conditions, such as diabetes or cardiovascular disease.

The current “repeat prescription” system allows patients to request a further supply of medicines without the inconvenience of another doctor’s appointment. Continue reading →

Few topics in the NHS have provoked as much controversy as the use of external management consultants. They provide advice on strategy, organisation and financial planning, and help implement new IT systems and other changes.

While some claim that this brings much needed improvements, critics question their value – particularly at a time when the NHS is strapped for cash. Even Patrick Carter, recently charged with reviewing NHS efficiency, admits that he has “a bugbear with employing management consultants”. Continue reading →

As winter continues, so does the usual soul searching about the state of the UK’s National Health Service (NHS). Images of ambulances backing up outside emergency departments and patients lying on trolleys in corridors haunt politicians and the public alike.

Demand on the NHS, which is always high, increases over the coldest of seasons, when threats to health are greatest. Generally, more than 20,000 extra deaths occur from December to March than in any other four-month period in England and Wales. That number varies considerably, however – from 17,460 in 2013-4 to 43,850 in 2014-5 (which was not even a particularly cold winter). And there has been no evidence of a decreasing trend since the early 1990s, despite the national flu immunisation programme. Continue reading →

The 9th-15th October is Baby Loss Awareness Week, which provides a chance to raise awareness about the issues surrounding pregnancy and baby loss in the UK. Our team has over 10 years of research experience in what makes effective training for staff involved in care for bereaved parents, and seven years working to end preventable harm related to stillbirth.

We welcome the House of Commons debate on Tuesday 10th October 2017 as part of Baby Loss Awareness Week, and have drawn on our recent research at the University of Bristol to contribute to this debate.

Our research has found that bereavement care is inconsistent across UK hospitals, and variable in quality. Bereaved parents are not always involved in decision-making, and parents may not be aware of the process when hospitals review their baby’s death. Healthcare staff may not be supported in caring for parents.

NHS England spends over £20 billion every year on goods and services. A significant part of the remainder of NHS non-salary budget involves the commissioning of health care services. This expenditure and commissioning is controlled by NHS procurement rules, which in part derive from EU law. NHS procurement rules are regularly criticised for imposing excessive red tape and compliance costs, and calls for NHS procurement reform to free it from such strictures are common.

In this context, Brexit could be seen as an opportunity to overhaul NHS procurement and to move away from the perceived excesses of EU law. This post concentrates on two issues. First, does EU law prevent significant reforms of NHS procurement and, if so, can Brexit suppress such constraints? Second, is the way Brexit is unfolding conducive to an improvement of NHS procurement? Continue reading →

Dr Sean Cowlishaw, Research Fellow at the Centre for Academic Primary Care, University of Bristol

That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.

The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling machines, called Fixed-Odds Betting Terminals (FOBTs), which now occupy the high street (within betting shops) and allow punters to wager up to £100 every 20 seconds.

Yet Britain doesn’t have much insight into its problem with gambling. Compared to most other addictive behaviours, involving drugs or alcohol for example, gambling is largely ignored by health services and public health agencies. This is partly because gambling is a hidden concern. It does not manifest with physical warning signs. Indicators are usually visible in extreme cases only, and generally following major life crises such as extreme debt or relationship breakdown. Continue reading →

Management consultants are powerful beasts. They can mould businesses and guide governments, both in high-profile projects and behind the scenes. They do this largely free from any specific regulation and, if revenue is anything to go by, continue to thrive in our uncertain world.

But there are constraints and scrutiny at work too – and they are increasing. A recent studyby researchers at the universities of Bristol and Cardiff in the UK shows how one of the most powerful consultancies, McKinsey & Co., is facing up to new and threatening pressures from clients, governments, NGOs and market forces.

Consulting firms like McKinsey, Booz Allen or Boston Consulting exercise power in three main ways: they have vast resources at their disposal; they are able to intervene in decision-making processes; they can influence what their clients think. In terms of resources, McKinsey not only possesses significant economic capital but its CEO-heavy alumni network provides it with an instant sales route into the Fortune 500 list of major companies. Its knowledge resources are the envy of universities the world over. The McKinsey Global Institute, for instance, is one of the largest management research organisations.